Figure 4. Angiogram from R ECA injection
Greg Zaharchuk, MD, PhD,
is an Assistant Professor of Radiology
at Stanford University.
A 76 year-old man with recent onset of right-sided tinnitus
(ringing in the ear).
An internal auditory canal protocol was scanned on the
Discovery MR750, including T2 FSE and 3D ASL pre-contrast
and T1 SPGR post-contrast.
MRI was negative except for 3D ASL hyperintense signal in
the right jugular region, suggestive of dAVF. CTA one week
later was negative (not shown). Angiogram two weeks later
demonstrates dAVF of the right marginal sinus (arrows)
supplied predominantly by the ascending pharyngeal
and occipital branches of the right external carotid artery.
In this case, 3D ASL helped us identify a treatable lesion
not seen on conventional techniques. By utilizing non-contrast perfusion techniques, such as 3D ASL, more
subtle cases could potentially be considered, as 3D ASL
does not suffer from the distortions inherent in contrast-perfusion approaches.
Greg Zaharchuk, MD, PhD, is an Assistant Professor of Radiology at Stanford University. He earned his medical degree from Harvard
Medical School, interned at Robert Wood Johnson University Hospital, and completed his residency and a fellowship at UCSF Medical
Center. The primary focus of Dr. Zaharchuk's research is the application and technical development of advanced magnetic resonance
imaging methods to assess brain hemodynamics and oxygenation in the setting of cerebrovascular disease, including Moyamoya
disease, transient ischemic attack, acute ischemic stroke, and vascular malformations.
Thu Le, MD, is a clinical fellow in the Neuroradiology section at Stanford University Medical Center.
Ryan A. Mc Taggart, MD, is a clinical fellow in the Neuroradiology section at Stanford University Medical Center.
Stanford University Medical Center provides both general acute care services and tertiary medical care for patients locally,
nationally, and internationally. The hospital's mission is to provide excellent care for its patients who live close by, as well as for those
who come from afar for treatment of complex disorders. Consistently ranking as one of best hospitals in the US by US News and
World Report and serving as the primary teaching hospital for the Stanford University School of Medicine, the hospital plays a key role
in the training of physicians and other medical professionals. It provides a clinical environment for the medical school's researchers
as they study ways to translate new knowledge into effective patient care.
Thu Le, MD
Ryan A. Mc Taggart, MD
AU TUMN 2011